PERSONALHEALTH
5ShadyWaysBigPharmaMayBeInfluencingYourDoctor
ByMarthaRosenberg/AlterNet
January23,2014
Until2010,whenthePhysicianPaymentsSunshineActpassed,requiringdoctorstodisclose
payments,theonlythingbetterthanworkingforPharmawasbeingadoctorwinedand
dinedbyPharma.
Pfizerjetted5,000doctorstoCaribbeanresortswheretheyenjoyedmassages,golfand
$2,000honorariachargestosellitspainkillerBextra(withdrawnfromthemarketin2005for
heartrisks).GSKsentdoctorstolavishresortstopromoteWellbutrin,theJustice
Departmentcharged.Johnson&Johnsonbestowedtrips,perksandhonorariaonTexas
MedicaidofficialstogetitsdrugRisperdalpreferredontheformulary,astatelawsuit
charged.Bristol-MyersSquibbenticeddoctorstoprescribeitsdrugswithaccesstotheLos
AngelesLakersandluxuryboxsuitesfortheirgames,Californiaregulatorssay.In
ChinaGSKischargedwithusinganetworkof700middlemenandtravelagenciestobribe
doctorswithcashandsexualfavors,andVictoryPharma,anopioiddrugsmaker,was
chargedwithtreatingdoctorstostripshows.Nice.
Ofcourse,Pharmarepsdidaswellasthedoctors.ThankstotheirBarbieandKendolllooks
andthefreesamples,giftsandlunchestheywouldbringmedicalstaff,theywouldoften
waltzintoseethedoctorbeforethesickandwaitingpatients.Somehadtheirownlounges
atmedicaloffices.Sincethe2010sunshinelaw,partoftheAffordableCareAct,wentinto
effectin2013,drugcompaniesmustdisplaythedoctorsandgroupstheypayontheir
websites.ThatincludestheirpaymentstofauxgrassrootsgroupslikeGoRedForWomen
andtheNationalAllianceonMentalIllness,orNAMI,whicharewidelyseenasPharma
fronts.Butwillitmakeadifference?Foryears,doctorshavealsobegunpresentationswith
slidesdetailingtheirPharmafundingbutitdoesn'tseemtoaltertheircredibilityoraudience
cynicism.
Whenitcomestoacknowledgingtheinfluenceofgiftsandmoneyonbehavior,doctors,like
everyoneelse,sufferfromself-delusion.Mostsaytheybelieveitaffectstheotherguy,not
them,andmanybecomeoffendedattheideathattheyare"forsale."
"Myprescribingneverchangesbecauseonceamonthadrugrepbringsinatrayof
sandwiches,"MariaCarmenWilsontoldtheTampaBayTimes.(WilsonwasEliLilly's
number-twoearnerinFloridain2009,thepaperreports.)It'stemptingtoasksuchdoctors
thatifthelargessedoesn'taffectthem,whenwasthelasttimetheyprescribed
thecompetitor'spill?Wouldanyonebelieveorevenreadthejournalismofareporterwho
acceptedanhonorariumorspeaker'sfeefromthesubjectshereportedon?Evenifshe
claimeditdidn'tinfluenceher?
TripstoresortsandstripclubswilllikelycontinuetodiminishunderthePhysicianPayments
SunshineAct,buttherearemanyotherways,oftensneaky,thatPharmacanenticedoctors
toprescribeitsexpensive,patentdrugs.
1.SpyingonPrescribing
LiketheNSAspyingprogram,shamelessspyingondoctors'prescribinghabitssparesalmost
noone.Recently,thefullsweepofIMSHealthHoldings'prescriptiondataminingwas
revealedbyProPublica,whichreportedthatitscollectionincludesover85percentofthe
40
JIAFM, 2005 : 27 (1). ISSN 0971-0973
UNETHICAL RELATIONSHIP BETWEEN DOCTORS AND
DRUGS COMPANIESDr. R.K. Bansal, Assistant Professor,
Dr. Sanjoy Das, Associate Professor,
Department of Forensic Medicine & Toxicology, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun
ABSTRACT
Medicine is a noble profession. The primary aim of medical profession is to render service to humanity.
Financial gain is a subordinate consideration.[1] But it has been observed globally that medical practitioners
in conjunction with pharmaceutical companies are prescribing and thereby promoting unnecessary
drugs just for the sake of monetary gains. This article reviews the salient aspects of the relationship
between doctors and drugs companies and its future consequences.
Key words : Medical Ethics, Drug companies, Prescription, MCI, RMP
INTRODUCTION
The interaction between doctors and medical
representatives (popularly known as MRs) is
almost as old as the medical profession itself. The
basic role of a medical representative is to apprise
the doctor about his company's products including
the drugs. There is nothing wrong in that as long
as the ultimate beneficiary of this information is
the patient. After all, continued professional
development is an essential component of a good
health care system. Even the Medical Council of
India expects that every registered medical
practitioner should try to up grade his knowledge
and skill for the betterment of his patients.[2]
Unfortunately, there is often a conflict
between the interests of the patient and those of
the doctors as far as the drug promotion is
concerned. WHO defines drugs promotion as all
informational and persuasive activities by
manufacturers, distributors to induce /influence the
sale and use of medicinal drugs. Drug promotion
has an important bearing on the rational use of
drug; on drug -price control mechanism; on equity
of drug distribution - all making it a central public
health issue. Often, drug promotion strategies
adopted by various drug companies are too
attractive to be resisted by a doctor. This, in turn,
places the interest of the doctors ahead that of the
patients. Doctors, who are frequently in contact with
medical representatives, are more likely to
prescribe newer and expensive drugs of their
favourite pharmaceutical companies to achieve
their selfish end i.e. to receive more and more
financial gain from the companies as cutbacks. In
our country, the doctors are held in high esteem
by the gullible patients. They are considered second
to 'Gods' by most patients. Therefore, doctors may
prescribe expensive drugs of their favourite
pharmaceutical companies with scant regard for
the expense borne by the poor patients.[3,4]
Interaction between drug companies and
doctors are pervasive. Relationships of doctors with
drug companies begin when they are just medical
students attending the various clinical OPD's and
wards, continue during internship and residency
training, and persist throughout their professional
careers.
The Nature and Effect of the Relationships
The drug-companies interact with doctors in
order to promote their medical products. They
reach out to almost all concerned doctors to attain
their goals. The doctors are compensated
adequately in the form of gifts and other incentives
by drug companies. Consequentially, both the
parties are benefited from this interaction with
potential consequences for patients. Few doctors
may be morally so stout that they continue to
prescribe those medicines that appear to be most
beneficial as well as economical to their patients
despite being in contact with so many drug
companies. The aggressive marketing strategies
by the companies just act as tools of information
for them. But the prescribing behavior of a vast
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15/11/15 17:44How Much Are Drug Companies Paying Your Doctor? - Scient if ic American
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H ow M uch Are Drug Companies Paying Your Doctor?New data released today will promote transparency and help patients know when docs receive money from product makers
By Charles Ornstein, Eric Sagara and ProPublica | September 30, 2014 |
This story was co-published with The New York Times.
On Tuesday, the federal government is expected to release details of payments to
doctors by every pharmaceutical and medical device manufacturer in the country.
The information is being made public under a provision of the 2010 Affordable Care
Act. The law mandates disclosure of payments to doctors, dentists, chiropractors,
podiatrists and optometrists for things like promotional speaking, consulting, meals,
educational items and research.
It's not quite clear what the data will show 2014 in part because the first batch will be
incomplete, covering spending for only a few months at the end of 2013 2014 but we
at ProPublica have some good guesses. That's because we have been detailing
relationships between doctors and the pharmaceutical industry for the past four
years as part of our Dollars for Docs project.
We've aggregated information from the websites of some large drug companies, which publish their payments as a condition of settling
federal whistle-blower lawsuits alleging improper marketing or kickbacks. Today, in cooperation with the website Pharmashine, we've
added data for 2013, which now covers 17 drug companies accounting for half of United States drug sales that year. (You can look up
your doctor using our easy search tool.)
Here are some facts we've learned from the data:
M any, many health professionals have relationships with industry.
Dollars for Docs now includes 3.4 million payments since 2009, totaling more than $4 billion, of which $2.5 billion was for research.
For 2013 alone, there were 1.2 million payments valued at nearly $1.4 billion.
It's not possible to calculate the exact number of physicians represented, because drug companies haven't used unique identification
numbers that cross company lines. But it's clear that the figure is in the hundreds of thousands.
Excluding research payments, the drugmaker Pfizer appeared to have interactions with the most health care professionals last year 2014
about 142,600. AstraZeneca came in second with about 111,200. Johnson & Johnson and Forest Labs each had nearly 100,000. There